The role of oblique spinous process abutment in the pathogenesis of degenerative lumbar scoliosis: an in vitro study

PURPOSE: To evaluate the efficacy and utility of SPECT/CT as a diagnostic modality and preoperative planning tool in patients undergoing fusion surgery for low back pain and/or leg pain. STUDY DESIGN/SETTING: A prospective cohort study (n525) performed over a 2-year period. PATIENT SAMPLE: All consecutive patients requiring lumbar spondylodesis for back pain and/or leg pain included. OUTCOME MEASURES: Clinical outcome measures included EQ-5D, EQ-5D VAS, ODI and VAS Pain Scores. METHODS: SPECT/CT fusion imaging was performed in conjunction with standard CT and MRI preoperatively to guide patient selection and surgical planning. Clinical outcome measures were collected preoperatively and at 6 weeks, 6 months and 1 year postoperatively. RESULTS: SPECT/CT fusion imaging demonstrated increased sensitivity for facet degeneration when compared to MRI. No difference was identified when comparing SPECT/CT to standard CT to assess disc degeneration. There was a significant improvement in all clinical outcome measures assessed preoperatively and followed out to 1-year postoperatively. Mean ODI score improved from 58.92 to 12.0; VAS back pain score improved from 7.46 preoperatively to 1.0; VAS leg pain score improved from 4.15 to 0.25. CONCLUSIONS: SPECT/CT fusion imaging is an excellent adjunct to existing imaging modalities, facilitating accurate level selection in patients undergoing lumbar fusion surgery for low back pain and/or leg pain. Lumbar fusion surgery guided by SPECT/CT fusion imaging was associated with excellent postoperative health related quality of life (HRQOL) outcome measures. CONFLICTS OF INTEREST: None. FUNDING SOURCES: None.